We each have great social and cultural associations with language. The act of communication itself is the most important aspect of language. First and foremost we consider language to be a mode of communication to express our thoughts, ideas, and desires. It’s something we pick up naturally from birth and something most of us take for granted. Language helps us to define ourselves. It helps us to articulate who we are and what we consider ourselves to be, and “it is the means by which we make sense of ourselves and our world, because it’s only by naming things that we can order then in ways that have meaning” (Holloway, Kane, Roos, and Titlestad, 2). Self-identity is of the utmost importance, and the main way we define ourselves is through the use of language. But imagine that all of a sudden you are no longer to communicate with those around you. Your speech, writing, and reading capabilities are all lost or greatly affected. This is the case with people who are affected by aphasia.
There are two main types of aphasia. They have to do with the understanding and production of language. Aphasia is “a general impairment in previously established levels of language functioning associated with localized cerebral pathology” (Eisenson, 1). The impetus of aphasia can be any number of things, but often it is the result of a stroke, traumatic brain injury or a brain tumor. Not only do these people experience a stressful and frightening injury, but there are also great long-term implications. All of a sudden their language capabilities have evaporated and these people are left at a major loss. While these they once possessed the language skills we all accept naturally, they are now affected by an acquired language disorder. Their lives are changed forever because this impairment extends to innumerable aspects of everyday life.
Two of the most prominent classifications of aphasia are Broca’s aphasia and Wernicke’s aphasia. They are each associated with different regions of the brain. The type of aphasia exhibited depends on the area of the brain injured, either by a stroke or through some other form of brain trauma. These two different types of aphasia each affect various parts of the communication process, either language comprehension or language generation.
While it may at first seem that those affected by Wernicke’s aphasia are less affected by their brain injury because they can spontaneously generate immense quantities of language, those affected by Broca’s aphasia are in a way better off. While the expression of language is much more labored and difficult for aphasiacs with Broca’s aphasia, these patients still posses the comprehension capabilities that give language its significance. Broca’s aphasia must be infinitely frustrating because of the inability to generate language. It maintains the more crucial aspect of the two parts of language use: language comprehension. Comprehension, rather than generation, is the more important skill because there are many forms of communication, but being able to understand language in the first place is a prerequisite to any language interaction.
In Broca’s aphasia patients often have difficulty speaking as well as writing. While they can comprehend language, it is the production of language that is difficult for them. This is why Broca’s aphasia is also called ‘non-fluent aphasia.’ In Broca’s aphasia language production is difficult because the part of the brain that is affected is “postulated to contain representations of the motor images of words or the memory is of the motor operations necessary to produce sounds” (Aphasia and Language, 14). These aphasias are unable to remember how to physically produce sounds in order for speech. For this reason it is also known as motor aphasia. Patients diagnosed with this form of aphasia are afflicted with very labored and halting speech, though they maintain most comprehension capabilities. They can understand what a person says when speaking to them, but they are unable to respond in a concise, distinct manner.
As stated before, Wernicke’s aphasia affects a completely different part of the brain, and thus impairs language in an entirely different manner. While in Broca’s aphasia patients can understand language, those with Wernicke’s aphasia have great difficulty understanding speech. Although they experience problems understanding speech as well as written language, they have no problem producing language. More specifically, “Wernicke’s area is the primary area responsible for storing the auditory representation of words, the auditory images, or the memory of how words sound” (Nadeau, Rothi, and Crosson, 14). They are affected by word deafness and word blindness, “difficulty understanding spoken words” and “difficulty understanding written words” (Murdoch, 59). Patients with Wernicke’s aphasia often speak effusively, but their language makes little sense.
Sometimes the speech of aphasics with Wernicke’s aphasia can even degenerate into simple jargon, “continuous but unintelligible speech, with little or no transmission of information” (Nicolosi, Harryman, Kresheck, 108). They add superfluous words into sentences and often the meaning is indecipherable and nonsensical. In aphasics who speak in jargon, they “(maintain) the structure if not the substance of meaningful speech…. the jargon patient feels that he is communicating satisfactorily and so does not show the halts, hesitations and corrects that mark standard aphasic speech.” These patients have no conception that their communication is unintelligible. They are under the impression that their meaning is being conveyed as they intend. For this reason, this diagnosis of Wernicke’s aphasia is made more difficult because these patients are completely unaware of their speech errors.
The fact that these aphasics are not aware of their speech errors means that there is no room for self-correction. Self-correction is the means by which aphasics strive to recover their language capabilities. Nevertheless, if you don’t know that there is a problem there is no way you can even begin to fix the issue. On the other hand, those with Broca’s aphasia are completely aware of the speech errors they make because they are able to understand the sounds they produce. As a result, those with Broca’s aphasia have a much better recovery prognosis.
Ironically, the characteristics of each type of aphasia are opposite that of the other. But clearly both comprehension and generative abilities are imperative in language use. In order to communicate we must both understand and be able to output. Communication is a multidimensional process. When one of these parts is disrupted the whole of a person’s communication ability is affected.
In spite of the fact that aphasia affects a person’s ability to express their thoughts and ideas, the condition does not always affect the thoughts themselves. Simply the expression is affected because an individual is unable to access the necessary language. In most cases it is not that the thought process itself is impaired, though some researchers have suggested that the functional intelligence of these patients is decreased with even slight gradations of aphasia. Still, they assert that when all conditions such as noise are controlled and the conditions are at their optimum, particularly recovered aphasics are able to function at or near their premorbid levels, “especially when they are not called upon to explain their thinking in language” (Eisenson, 9). They are able to think coherently, just not think about the way in which they think.
According to the National Aphasia Association, there are about 1 million Americans who are affected by one of the many acquired language disorders that are collectively known as aphasia. The majority is afflicted with aphasia as the result of a stroke. The next leading cause is closed head injuries. There are some types of aphasia that are temporary, but both Broca’s and Wernicke’s aphasias are permanent. Speech therapy, especially if started within 6 months of the traumatic brain injury can help to reverse some of the effects of aphasia. This is the main way to cope with this decreased language capability. While the skills can never be fully regained, some recovery is possible, and there are measures that can help individuals utilize their remaining abilities for the purpose of communication.
Communication is so important because it allows us to convey thoughts, ideas, and desires. It is a method to relay meaning. But it is not sounds themselves that have meaning. We have assigned an arbitrary set of sounds and syllables to an object in order to name it, thus bringing order to our world. But it is not those syllables that create the significance; humans give the words their significance. The words are only important because of the meaning we attach to them. This meaning comes from society’s generally accepted understanding of the connotations of the word. Comprehension of the meaning attached to a sound is the very foundation of language. Those affected by Wernicke’s aphasia are lacking this elemental characteristic of communication. Speaking is only important if it conveys a message. Otherwise, if there is no content, then there is no point in creating sounds or phrases.
As previously stated, language significance develops from our ability to recognize the meaning humans have attached to words. While in Wernicke’s aphasia this is the part of the brain that is damaged, Broca’s aphasia generally preserves the aphasic person’s ability to understand. As a result, those with Broca’s aphasia are at an advantage on multiple levels. Not only do they understand the language itself, they are also aware of their language capabilities. They are able to understand that they make errors when they speak. This is not the case with those afflicted by Wernicke’s aphasia. Wernicke’s aphasiacs are incapable of realizing their speech errors because they cannot understand spoken language.
As you can imagine, aphasia is such a difficult condition because it affects a person’s entire relationship with the world. Communication is intrinsic to not only self-definition, but also in our society. Language allows us to make sense of our environment, through our reading and listening capabilities. Speech and writing are methods through which we can express ourselves. All of these abilities are imperative to the way we live our lives.
Beyond the societal uses of language, language also allows us to develop a self-concept. Self-concept is the way in which we see ourselves. Self-definition is important because it is the way in which we differentiate ourselves from the nearly seven billion other people on the earth. It allows us to feel that we are unique individuals and to think of ourselves as autonomous. In addition, it not only influences the way we see ourselves, but also the ways in which we are perceived. This perception of ourselves is central to the way we process information and communicate with others. Thus aphasiacs not only experience a loss of their abilities to communicate, but also experience a sort of identity crisis.
No longer are they able to interact in their traditional ways with their family and friends. These relationships are newly strained and the inability of expression often leads to depression and immense feelings of isolation. These feelings of aloneness can lead to low self-esteem. Low self-esteem, in other words a low self-concept, which can be further detrimental to language skills because it most often results in a lack of confidence in language ability.
Still, it is important to recognize that communication is not limited to the verbal transmission of information. While the ability to speak may seem imperative to communicate thoughts and ideas, nonverbal communication plays a significant role in the transfer of information, as well. Body language and facial expression say more than you may think. These secondary modes of transmission are considered to be universal constants of language. Even though two people may not speak the same language, oftentimes they can still understand the essence of what a person is trying to communicate through these alternative means.
As it turns out, while most communication proves difficult for people affected by aphasia, “aphasic persons are much better able to express their feelings, especially if they are strong feelings, than they are able to express or communicate their thoughts” (Adult Aphasia, 6). While some of this does have to do with the fact that in aphasiacs the brain is better able to communicate phrases involving personal pronouns, I believe that much of this is also conveyed through nonverbal means including gestures and facial expressions.
We generally underemphasize the importance of nonverbal communication. In fact, it has been estimated that “65 percent of the social meaning of a message in a face-to-face interpersonal communication is transmitted through nonverbal communication” (Applbaum, Anatoni, Hays, Jenson, Porter, ans Mandel, 110). While you can’t understand that a person is trying to communicate, “please pass the salt” through nonverbal communication, you can understand underlying emotional messages through nonverbal means. I would argue that these are often the more important messages anyway. While the more everyday, practical dialogue is incredibly difficult, the underlying sentiments of general emotions are much more explicit through these alternative means. We may simply be less aware of these nonverbal cues simply because we pick up on them naturally. We gather information in these ways subconsciously. They are skills that we learn naturally from birth, just as surely as we learn to speak.
There are generally considered to be four types of nonverbal cues which include proximity and space, body movement and facial expression, eye contact, and vocal cues such as tone of voice that are not out rightly stated in the spoken language. Of course lack of speech would affect which nonverbal cues can be utilized in communication, nevertheless, considering the amount of information we can garner from these unspoken signals combined, individuals are undoubtedly able to gain large quantities of information from even a few of these categories.
While these nonverbal signs should be present in both Broca’s aphasiacs and Wernicke’s aphasiacs, for this nonverbal expression of emotion is not affected, Broca’s aphasiacs maintain much over those with Wernicke’s aphasia. While they do have a clinically proven improved long term prognosis, their advantage stems from the very nature of the disability, not simply the long-term recovery outcome. As stated previously, the mutual understanding of words is what gives language meaning. Language in and of itself is inconsequential. This fact is demonstrated when you overhear people speaking a foreign language. While you may be able to guess at some of their conversation, most of the inferences you can make come from the nonverbal cues discussed above.
Beyond understanding of these nonverbal cues, comprehension of spoken language is most important, more so than random generation of nonsensical phrases and jargon. The reason stems from the fact that when you understand spoken language, as those with Broca’s aphasia can, you are able to respond to the environment and to external stimuli. Although they may not be able to respond in the usual manner, through speech, they still maintain this connection to others and to the world as a whole. Conversely, Wernicke’s aphasia does not allow for such interpersonal connections. The lack of verbal and written comprehension is truly isolating because they have no way to make these language connections with others.
Not only are they unable to make these connections from external input, but when they do strive to communicate and to produce language as they are capable their speech has little or no meaning because it is incomprehensible. Alternatively, while those afflicted with Broca’s have a difficult time speaking, when they do speak they can hear their mistakes and are thus able to self-correct, thereby making their efforts at language more significant and expressive. A study completed in 1991 and cited in Aphasia and Language showed that in Broca’s aphasiacs, “communicative competence can be present in spite of linguistic incompetence” (289). In the study a patient had been asked a series of questions about the events that had brought him to this aphasiatic state, specifically about his stroke, and with the help of his spouse who simplified and paraphrase the questions for him the patient was able to answer the line of questions. This would not have been possible for patients with Wernicke’s aphasia who are word deaf.
Both Broca’s aphasia and Wernicke’s aphasia are greatly debilitating medical conditions. These brain injuries have great long lasting impacts that primarily influence the ability to understand and articulate language, but have secondary effects including depression and decreased sense of identity. Aphasia is a devastating condition because language and communication are such integral parts of our everyday lives. While there are many forms of communication, including that which can be deduced from nonverbal cues, being able to understand speech in an inherently important ability that connects us to those around us. It is the meaning of words that is important, not the simple use of these sounds and phrases. The message imbued in speech is what is significant. For this reason those who are diagnosed with Broca’s aphasia are at a significant advantage over those with Wernicke’s aphasia. Not only has it been shown that they have a better clinical prognosis, but those with Wernicke’s aphasia are not able to understand the outside world because of their lack of language comprehension. It is these connections that Wernicke’s aphasiacs are incapable of, connections made through understandings established with those around us that give life purpose and value.
Works Cited
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Welcome to the National Aphasia Association. Web. 07 Jun 2010.
